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Incidence of Return Visits to the Emergency Department Following Appendectomies within the Global Period: An Analysis of Incidence and Cost-Effectiveness of Post-Appendectomy Emergency Department Visits
Erica Gross1, Francesco A Aiello2, Robert Kozol2, Rajiv Chandawarkar2, Anthony Morgan3, Andrew Duffy4, Walter Longo4
1University of Connecticut, West Hartford, CT;2University of Connecticut, Farmington, CT;3Saint Francis Hospital, Hartford, CT;4Yale-New Haven Medical Center, New Haven, CT

Introduction: The Emergency department has become a source of primary care for some patients despite the lack of necessity for this level of care. Post-operative patient care within the global period encompasses routine follow-up care, but some patients will present to the ED instead of a surgical office for post-operative issues. We report the incidence, nature, cost effectiveness, and warrant of Emergency Department (ED) visits within the global period following appendectomies.
Methods: Retrospective cohort analysis of 597 consecutive patients undergoing open (80) or laparoscopic appendectomies (517) at a single institution between 10/1/2001 and 2/15/2006 presenting to the ED within ninety days post-operatively.
Results: The overall incidence of presentation to the ED was 45 patients (7.54%) of which 29 (64%) were surgically related. Only 5 (17.2%) of the surgically related visits required admission. The most common presenting complaint was abdominal pain (17 patients, 58.6%) with 5 patients requiring further intervention, followed by wound complication (5 patients, 17.2%), nausea/vomiting/diarrhea (3 patients, 10.3%), fevers/chills (3 patients, 10.3%), and staple removal (1 patient, 3.44%). The majority of patients received laboratory or radiological tests (28 patients, 97%). CT imaging was performed on 10 patients (34%) with diagnostic findings in 50%. There was no correlation between type of procedure, gender, or age and return visits to the ED.
Conclusion: Judging by the few surgical reasons for post-operative return visits, most of the ED visits and incurred additional medical care costs may have been avoided.


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